Noninvasive Diagnosis Of Tuberculous Pleural Effusion Score Model And Validation Studies

Objectives: To reset and revaluatemolecular markers used to diagnosis of tuberculous pleural effusion(TPE)on the base of pleural biopsies under thoracoscopy.Farthermore,to develop and validate a diagnosis of TPE score base on chosenmolecular markers.This is the first meta-analysis of randomized controlled trials(RCTs)determining the clinical impacts of statin therapy on patients with secondary PH.Methods: Part I Step one:A retrospective study was conducted on patients with pleural effusion were diagnosised by pleural biopsies under thoracoscopy in 1 Jan 2010 to 31 Dec 2014.Receiver operating characteristic(ROC)curveswere used to determine the optimal cutoff values of candidate molecular markers and included in a conditional logistic regression model to develop a diagonsis score.Step two: Accuracy of the diagnostic score was estimated on a separate external validation sample derived from multicentric perspective study cases in 1 Jan 2015 to 1Nov 2016.part II:Electronic databases and manual bibliographical searches were conducted.Eligible studiesincluded RCTs of at least 3 months that evaluated statin therapy as compared with control in adult patientswith secondary PH.Statistical analyses were performed to calculate mean difference,relative risks,and95% confidence intervals using random-effect model.Results: First step is to establish the thoracic fluid adenosine deaminase(p ADA?24U/L),thoracic fluid carcinoembryonic antigen(p CEA?6.5mg/L),chest fluid phosphate dehydrogenase(pLDH < 710U/L)as the independent factors.Scoring model established as: Score = pCEA?6.5×3+p ADA?24×5+p LDH<710×3.Retrospective study data validation results showed that the Score 6 or higher in the diagnosis of tuberculous pleural effusion,sensitivity degree 99.5%,specific degree 92% and area under the curve(AUC)0.973.Second,our prospective study data validation results showed that the Score 7 or higher in the diagnosis of tuberculous pleural effusion,sensitivity degrees 93.4%,specificdegrees 99.4%and AUC 0.97.Other study centers' data validation results showed that the Score 7 or higher in the diagnosis of tuberculous pleural effusion,sensitivitydegrees99.8%,specific degrees90% and AUC 0.95.A total of 5 RCTs were identified and included in this study.4 trials reported the effects of statinsin patients with both chronic obstructive pulmonary disease and PH,and the remaining 1 was based on PHdue to pneumoconiosis.We found that statin therapy was associated with increased 6 minute walk distanceand reduced pulmonary arterial pressure.There was no observed difference in the incidence of death,drugwithdrawal,and adverse event between statin and control group.Conclusions: pADA?24U/L,p CEA?6.5mg/L and pLDH<710U/L associated with TPE and have been used to develop and externally validate a new TPE diagnostic score.This could be used to target patients for diagnosis.Our findings demonstrate that statins could be safe and beneficial for patients withsecondary PH due to chronic lung diseases.However,larger RCTs with more patients and longerobservational duration are needed.